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Weekly Chest CasesArchive of Old Cases

Case No : 267 Date 2002-12-07

  • Courtesy of Kyung-Hyun Do, M.D., Joon Beom Seo, M.D. / Asan Medical Center, Seoul, Korea
  • Age/Sex 30 / M
  • Chief ComplaintFever and chill for 1 month.
  • Figure 1
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  • Figure 4

Diagnosis With Brief Discussion

Diagnosis
Pneumocystis Carinni Pneumoniain a AIDS Patient
Radiologic Findings
Chest radiograph shows diffuse and bilateral areas of ground-glass opacities in both lungs. HRCT scans show diffuse ground-glass opacities in both lungs. Mild interstitial thickening is associated in both lower lobes. Thin walled cysts in peripheral portion of right upper lobe is paraseptal emphysema.
He was diagnosed as HIV-positive 8 years ago. A CD4 level was 17 cells/ mm3. GMS staining of bronchial washing fluid revealed numerous pneumocystis carinii organisms. Serologic test for CMV was negative.
Brief Review
PCP affects approximately 65% of all HIV-infected patients at some points during the course of their disease. Although PCP may occur at a CD4 level higher than 200 cells/mm3, and it remains a common AIDS-defining illness, the diagnosis should be more strongly considered in a patients with CD4 cells below this level, and it is most common in patients with CD4 levels lower than 100 cells /mm3.
The most characteristic appearance on chest radiographs is the finding of diffuse bilateral interstitial infiltrates and/or ill-defined hazy consolidation. HRCT findings are known as patchy bilateral ground-glass opacities, often central or perihilar. CT findings in patients with PCP reflect the stage of disease. Initially, scattered foci of ground-glass opacity of air space consolidation can be identified. In treated patients with resolving of subacute infection, reticular opacities representing thickned interlobular septa and intralobular lines can be seen in association with ground-glass opacity.
Of particular interest is the frequency for cystic abnormalities and associated pneumothoraces in AIDS patients with PCP. Thin-walled cystic lesions are recognized in about 10-34% of cases radiographically, but they are more commonly identified with CT. The pneumatoceles were typically thin-walled with no intracystic material and no predilection for a particular area of the lung. Cysts related to PCP are usually multiple, occur most often in the upper parts of the lungs, and tend to decrease in size or resolve after the acute stage of the infection.
A definitive diagnosis of PCP requires the demonstration of organisms in sputum or bronchioloalveolar lavage fluid.
References
1. Webb WR, Muller NL, Naidich DP. High-Resolution CT of the Lung. Lippincott-Raven 1996 2nd edition. 212-219.
2. Sandhu JS, Goodman PC. Pulmonary cysts associated with Pneumocystis carinii pneumonia in patients with AIDS. Radiology 1989;173:33-35
3. Chow C, Templeton PA, White CS. Lung cysts associated with Pneumocystis carinii pneumonia: radiographic characteristics, natural history, and complications. AJR 1993;161:527-531
Keywords
Lung, Infection, Fungal infection, immune related, Pneumocystis Carinni Pneumoniain a AIDS Patient

No. of Applicants : 29

▶ Correct Answer : 19/29,  65.5%
  • - Annecy Hospital, France Gilles Genin
  • - Asan Medical Center, Korea Eun Jin Chae
  • - Choong-ju Hospital Konkuk University, Korea Chang Hee Lee
  • - CHU Grenoble, France Mathieu Rodiere
  • - Ewha Womans University Hospital, Korea Ji Young Hwang
  • - Ewha Womans' University, Mokdong Hospital, Korea Sung Shine Shim
  • - Gwangmoung Seongae Hospital, Korea Jiyong Rhee
  • - Hangang Sacred Heart Hospital, Korea Eil Seong Lee
  • - Hospital of Leon, Spain Inmaculada Herraez
  • - Inha university hospital, Korea Dong-Jae Shim
  • - Korea University Anam Hospital, Korea Bo Kyung Je
  • - Korea university Guro hospital, Korea Ok Hee Woo
  • - Ospedale di Jesi, Italy Giancarlo Passarini
  • - P.D. Hinduja Hospital, Munbai, India Sharad Bidari
  • - Sarang Hospital, Incheon, Korea Jung Hee Kim
  • - Seoul National University Hospital, Korea Ji Hoon Kim
  • - Stedelijk OLV Ziekenhuis Mechelen, Belgium Ivan Pilate
  • - Taipei Municipal Jen-Ai Hospital, Taiwan Hui-Ju Tsai
  • - Xray Clinic, Pune, India Anand Rahalkar
▶ Semi-Correct Answer : 10/29,  34.5%
  • - CHU Nancy-Brabois, France Denis Regent
  • - Dong-A University Hospital, Korea Ki-Nam Lee
  • - France Pierre-Yves Brillet
  • - France Dumont
  • - Jecheon Public Health Center, Korea Seung Hun Ryu
  • - Ondokuz Mayis University, Samsun, Turkey Cetin Celenk
  • - Paik hospital, Inje University, Seoul, Korea Seungil Baek
  • - Pohang St. Mary's Hospital, Korea Taegwon Kim
  • - Social Security Hospital, Ankara, Turkey Meric Tuzun
  • - Tokyo Kouseinenkin Hospital , Japan Noriatsu Ichiba
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